Braiding and Blending Funds to Support Community Health Improvement: A Compendium of Resources and Examples

 
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                 until Tuesday,
                 December 17
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                                  Braiding and Blending Funds
                                  to Support Community Health
                                  Improvement: A Compendium of
                                  Resources and Examples

                                  H
                                           ealth conditions and risk factors often overlap and co-occur, and
                                           are intimately tied to social and structural determinants of health.
                                           As a result, it is essential that health improvement efforts center on
                                  prevention and policy, systems and environmental changes that cut across
                                  sectors.
                                  There is widespread recognition that such multi-sector/collective impact
                                  work is necessary to improve health, education and broader well-being
                                  outcomes in communities across the U.S. Many organizations and
                                  individuals are exploring the intersection of health with housing, community
                                  development, education, and other sectors.
                                  Within the realm of public health, we have seen the proliferation of efforts
                                  like:
                                       - Accountable Communities for Health (ACHs), described in detail
                                          in briefs by the Center for Health Care Strategies and Prevention
                                          Institute - which bring together health, social service and other sectors
                                          to improve population health and clinical-community linkages and are
                                          being tested by several states participating in the Center for Medicare
                                          and Medicaid Innovation’s (CMMI) State Innovation Models (SIM)
                                          initiative;
                                       - Purpose Built Communities – which take a holistic approach to
                                          revitalizing distressed neighborhoods that includes housing, education
SEPTEMBER 2018

                                          and comprehensive community wellness resources; and
                                       - Invest Health – an initiative of the Robert Wood Johnson Foundation
                                          and Reinvestment Fund that supports multi-sector partnerships in 50
                                          mid-sized U.S. cities, aiming to increase private and public investments
                                          to improve health outcomes in low-income neighborhoods.
As noted in Trust for America’s Health’s Blueprint for a Healthier America 2016, these local, multi-
    sector, health improvement partnerships require bringing together a diverse range of funding streams
    in order to be sustainable.

    There has been much momentum around this issue recently, including delineation of the various
    types of financing structures that can support community prevention and population health (including
    an outline of innovations in financing population health, as well as a typology of potential financing
    structures for population health); discussion of what a balanced portfolio for community health might
    look like and what it will take to get there; development of a model to provide the local infrastructure
    necessary to manage complex coordination of funding streams for community health improvement;
    federal agency policy guidance; and a federally authorized pilot program (Performance Partnership
    Pilots for Disconnected Youth, described in detail in a 2017 annual report to Congress) enabling states
    and localities to combine multiple federal funding streams to improve outcomes for disconnected
    youth.

    This issue brief focuses specifically on two key mechanisms by which to bring funding streams together
    to support community health improvement – braiding and blending. Braiding refers to coordinating
    funding and financing from several sources to support a single initiative or portfolio of interventions
    (usually at the community level). Braiding keeps funding/financing streams in distinguishable strands,
    so each funder can track resources. On the other hand, blending refers to combining different
    streams into one pool, under a single set of reporting and other requirements, which makes streams
    indistinguishable from one another as they are combined to meet needs on the ground that are
    unexpected or unmet by other sources.

    These are not new concepts and have been explored in depth as early as 2003, with the publishing of a
    guide, Blending and Braiding Funds to Support Early Care and Education Initiatives. While guides focused on
    braiding and blending at the federal, state, and local levels have been published in recent years, there
    is not a compendium of resources on braiding and blending to help inform state and local endeavors
    to braid and blend funds in order to support health improvement efforts in their community – that
    is what this brief aims to do, pulling together key resources and highlighting key examples. Notably,
    resources and examples were selected to reflect the breadth of work in this area, and do not constitute
    a comprehensive list.

    GUIDES AND TOOLKITS
    Blended and Braided Funding: A Guide for Policy Makers and Practitioners
    This 2014 guide from the Association of Government Accountants (AGA) provides “how to”
    information on increasing efficiency and effectiveness of funds through blending and braiding for
    those who set government policy, including Congress and presidential administrations, state legislators,
    governors, city councils, and mayors. The guide provides an overview of blending and braiding,
    including challenges of the current federal funding system; highlights several federal statutes that
    authorize blended funding or increase flexibility in other ways; and concludes with key lessons learned
    from existing initiatives and a decision framework for those considering blending or braiding funds.

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Blending, Braiding, and Block-Granting Funds for Public Health and Prevention: Implications for
States
This 2017 publication of the National Academy for State Health Policy (NASHP) provides
recommendations for states interested in maximizing their ability to coordinate work and resources
across programs through blending and braiding, based on insights gleaned from a convening of state
public health and Medicaid policymakers. The paper examines historic and existing sources of federal
funding to states to support public health, explores how use of those funds intersects with Medicaid
waiver authorities to support public health goals and proposes state responses – including blending
and braiding – to various federal funding scenarios.

Braiding & Blending Funding Streams to Meet the Health-Related Social Needs of Low-Income
Persons: Considerations for State Health Policymakers
This 2016 NASPH brief highlights non-Medicaid funding sources states can blend or braid to address
social determinants of health and other needs not typically covered by Medicaid and provides a
continuum of options state Medicaid, public health and other policymakers can consider to coordinate
funding to better serve adult Medicaid beneficiaries.

Spark Policy Institute Blending & Braiding Toolkit
This toolkit walks communities through various phases of beginning to blend and braid funds, from
identifying a vision and partners to defining the program/services provided to exploring finance
options to developing – and then implementing, tracking and improving – a coordinated financing
plan. The toolkit also includes some case studies and additional resources to help communities identify
potential funding streams for blended or braided models.

Accountable Communities for Health – Strategies for Financial Sustainability
This brief outlines a host of strategies intended to provide guidance for communities wishing
to implement effective Accountable Communities for Health. One of the key implementation
strategies highlighted is braiding and blending funding across efforts in the areas of clinical services,
social services and community resources, clinical-community linkages, broader policy, systems and
environmental changes as well as backbone functions (e.g., convening, coordinating programs and
funds, providing oversight).

Blending and Braiding Early Childhood Program Funding Streams Toolkit
This 2013 toolkit from the Ounce of Prevention Fund is designed to provide state advocates and
policymakers with strategies, tools, resources and options to make policy choices that facilitate blending
and braiding funding streams to improve early learning programs for vulnerable children and working
families. The toolkit includes state data tables and worksheets to facilitate an understanding of the
current funding landscape within a state.

Blending and Braiding Funds and Resources: The Intermediary as Facilitator
This 2006 brief by the National Collaborative on Workforce and Disability focuses on how intermediary
organizations can facilitate the blending and braiding of funds and resources to encourage cross-
systems collaboration. While the brief focuses on blending and braiding within the context of
improving educational and employment outcomes for youth, including those with disabilities, the
strategies outlined and discussion of the role of intermediaries in blending and braiding are relevant
across issues. The brief includes a tables outlining state- and local-level intermediary activities to
facilitate use of alternative funding strategies.

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FEDERAL INITIATIVES
    There are a few Federal initiatives designed to encourage braiding and blending of Federal funding
    streams, including:

           -P
             erformance Partnership Pilots for Disconnected Youth – This program brings together
            the U.S. Department of Education (ED), the U.S. Department of Labor (DOL), the U.S.
            Department of Health and Human Services (HHS), the Corporation for National Community
            Service, the Institute of Museum and Library Services and other related agencies to provide
            opportunities for communities to test innovative ways of improving outcomes for disconnected
            youth. Because of statutory authority granted to the agencies for this program, pilot sites can
            propose blending funds from various federal programs and may have certain intra-program
            requirements waived. This model for blending funds, combined with accountability for results,
            is intended to ease administrative burden and improve outcomes for youth.

           - Promise Neighborhoods – Inspired by initiatives such as the Harlem Children's Zone,
              this Department of Education program supports projects that are designed to create a
              comprehensive continuum of education programs and family and community supports, with
              great schools at the center, that will significantly improve the educational and developmental
              outcomes of children from birth through college and career, in the nation's most distressed
              communities. In addition to the funds awarded directly through Promise Neighborhood
              grants, recipients are required to acquire substantial matching funds (sources include private
              entities and government agencies), which are braided together to build cradle-to-career
              continuums.

           -N
             ow is the Time – This plan to reduce gun violence, make schools safer and increase access
            to mental health services, began in 2013. The U.S. Department of Education (ED), Substance
            Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Department of
            Justice (DOJ) created three grant programs designed to work in collaboration under this
            umbrella – requiring applicants for grants from one of these agencies to also apply for grants
            from another (and sometimes only allowing recipients of one grant to apply to another or
            requiring partnership with an entity that applied to another grant); aligning application
            timelines; requiring submission of grant coordination and implementation times (for
            successful applicants to more than one grant under this initiative); and coordinating training
            and technical assistance through a single provider.

    STATE AND LOCAL EXAMPLES
    State and local public and private entities are successfully braiding and blending funds, particularly
    when they have the appropriate infrastructure to support these efforts, as demonstrated by the
    examples provided here. These examples exist in a range of sectors, including health, children and
    family services, early education, education, domestic violence, housing and community development.

    Local Examples

    Family League of Baltimore
    The Family League of Baltimore is a nongovernmental local management board, established in 1991 by
4    TFAH • www.TFAH.org
the Maryland General Assembly, to target government resources to local organizations and coordinate
services for child and family services. Family League partners with a variety of organizations, including
My Brother’s Keeper Baltimore and the Family Literacy Coalition, to fund and support capacity
building; collaboration; the reduction of duplicate services among public and private stakeholders;
wider implementation of evidence-based programs; and the promotion of policy and practice system
changes. The program receives support from around 40 different funders to support a total budget
of $29.6 million (in 2016), including around $13 million from state grants; $13 million from local
government grants; $1.5 million in private grants; and $500,000 in federal grants. Around 93 percent
of funds are from government grants. Eighty percent is distributed to local organizations, 10 percent
supports technical assistance and 10 percent supports management and administration. As one
example effort, through B’more for Healthy Babies, the Family League of Baltimore is working with
the Baltimore Health Department to reduce infant mortality and improve the health of mothers and
babies through fitness and nutrition for postpartum women, hosting breastfeeding support groups
and conducting intensive community outreach to connect women with services. Infant mortality has
been reduced by 28 percent since the start of the initiative and is at the lowest point in history. And the
disparity between White and Black infant deaths has been reduced by nearly 40 percent.

Florida Children’s Services Councils
In Florida, state legislation enables counties to levy a tax or set aside a portion of their annual budget
– subject to voter approval – to fund a government entity called a Children’s Services Council (CSC).
These councils help fund organizations that serve children and families in the county where a council
exists. The councils also help make sure dollars are invested in programs that will provide the best
outcomes for children and families in their communities, with priorities aligned with the community’s
needs. Among other activities, councils monitor program/provider performance and serve as a hub,
convening child advocacy partners and providing leadership, coordination and oversight.

Spectrum’s School Health Program at Grand Rapids Public Schools
The School Health Program in Grand Rapids Public Schools (GRPS) in Michigan is a partnership
between the school district and Spectrum Health (a large health system in the area). The program
utilizes school health teams composed of registered nurses, licensed practical nurses and health
aides to provide direct services to students in 48 schools, including via four full-service school based
health centers. The program coordinates funding from several sources to support their school nurses
(Spectrum Health, the district budget, the local school district budget, and the State Department of
Education – including grants and funds set aside for students deemed high risk), and further braids
together public and private funding streams to allow for reimbursement and service provision under
a variety of health delivery models beyond the traditional school nurse reimbursement model. This
enables GRPS to provide services outside of the traditional school nurse model, such as dental services.
GRPS also partners with a local Federally Qualified Health Center (FQHC) to deliver health services
in their school-based health centers and via a traveling dental program. Because these services are
provided through an FQHC, they are eligible for Medicaid reimbursement and receive the FQHC
enhanced reimbursement rate. The School Health Program has produced significant improvements
in key school health indicators. In FY 2015, 97% of students at participating schools met current
immunization requirements to attend school and 98% of problems identified were resolved on-site by
the school health care team.

Public Health Improvement Fund in Allegheny County, Pennsylvania
In Allegheny County, Pennsylvania, a group of foundation executives established a joint fund known as
the Public Health Improvement Fund in order to coordinate the various streams of foundation funding
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available for the public health department. The fund, run out of the Pittsburgh Foundation, centralizes
    and blends funds initially made up of contributions from five local foundations to support public
    health infrastructure and more recently, a local health improvement plan (A Plan for a Healthier
    Allegheny). The two largest health care/insurance systems in the county have also joined the fund and
    there are plans to approach large universities in the area as well.

    Chicanos Por La Causa
    Chicanos Por La Causa (CPLC), a multistate Community Development Corporation, focuses on
    economic development, education, housing development and delivering of social services. CPLC serves
    over 200,000 low-income individuals annually through program sites in Arizona, Nevada and New
    Mexico. It provides a range of services, including youth and adult education, scholarships, behavioral
    health, domestic violence services, substance abuse treatment, parenting classes, HIV services, senior
    and immigration services, workforce development, real estate, housing and loans for entrepreneurs
    and small businesses. CPLC generates more than $50 million in revenue from the housing, health
    and other services it provides. In Phoenix, Arizona, via a partnership with UnitedHealthcare (which
    has 25,000 members within a 3 mile radius of the center), all clients are screened for social needs and
    referred to social services including job training, housing, financial services and transportation. A new
    data system enhances communications between social service providers, including referrals. To finance
    the effort, UnitedHealthcare has committed to provide CPLC access to up to $20 million in capital to
    acquire, develop and operate multifamily housing units and to provide a variety of need-based services
    for residents.

    Sojourner Family Peace Center
    Sojourner, originally founded in 1975, is the largest nonprofit provider of domestic violence
    prevention and intervention services in Wisconsin. The new Sojourner Family Peace Center, which
    opened in February 2016, provides a broad array of co-located services, including crisis housing,
    emergency services, law enforcement, assessments, counseling, and referrals. The new Center was
    financed through braiding of funds from innovative sources, including leveraging of New Market Tax
    Credits, community benefit dollars and other support from the Children’s Hospital of Wisconsin, and
    money from a State Building Commission matching grant. Sojourner braids funds from public sources
    (federal, state, county and city funding) (42 percent), United Way (9 percent), and private sources (48
    percent).

    State Examples

    Virginia Children’s Services Act
    Virginia’s Children’s Services Act is a case management model that blends funding streams across
    state agencies (social services, juvenile justice, education, and behavioral health) and allocates these
    funds to localities to support the needs of at-risk youth and families. It is overseen by a cross-agency
    State Executive Council for Children’s Services. The local funds are received and managed by the local
    Community Policy and Management Team (CPMT), which is appointed by the local governing body.
    The CPMTs authorize the funds to pay for the services recommended by the local Family Assessment
    and Planning (FAPT) teams. Localities also contribute matching funds to the CSA state pool and
    report to the state on pool expenditures as a whole; they do not report on expenditures by stream. At-
    risk youth are referred through a range of individuals or organizations or schools — and assigned to
    the local assessment and planning team who develop an individualized plan. A case manager helps the
    youth navigate and receive available services including education, healthcare, housing, transportation

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and food assistance. Through improved coordination of services and funding streams, case managers
have the flexibility to focus on tailoring services to the youth’s needs and avoiding unnecessary
bureaucracy.

Colorado Department of Education’s School Behavioral Health Services
The Colorado Department of Education provides behavioral health and substance use prevention
support in schools by funding full-time psychologists, social workers, counselors and nurses;
professional development and training; and resources to implement evidence-based programs for
substance use prevention, including universal screening. These efforts are financed by braiding funds
from marijuana taxes with funds from Medicaid and grants from the Substance Abuse and Mental
Health Services Administration as well as state-level personnel development and bullying prevention
and education grants.

Colorado Department of Human Services Blending and Braiding Initiatives
Colorado’s Trauma Informed System of Care (COACT Colorado) involves all child and youth service
agencies in the state (including the public mental health system, child welfare, juvenile justice and
education) and aims to develop a sustainable infrastructure to coordinate and fund services for families
of children and youth with complex needs. COACT Colorado is currently supporting 15 communities
across 17 counties. In El Paso County, the state is piloting a care management entity, a centralized
organization that blends funding, organizes services and supports, and serves as a hub of accountability
across agencies.

The Colorado Department of Human Services has also embarked on a Blending and Braiding Your
TANF (BBYT) Initiative, which includes technical assistance, tools, training, and demonstration
projects in six counties to help local communities learn to blend and braid multiple funding streams
with their Temporary Assistance for Needy Families (TANF) funds to support evidence-based and best
practice services, while still complying with TANF’s transparency and accountability requirements. As
part of this initiative, BBYT collaborated with Spark Policy Institute and others to produce guides on
blending and braiding, TANF for local communities and partnering with funders.

Blending and Braiding to Support Early Childhood in New York
To support efforts to blend and braid funds, the New York State Early Childhood Advisory Council
Finance Work Group commissioned Spark Policy Institute to produce state-specific guides, Early
Childhood Guide to Blending and Braiding in New York and Blending and Braiding to Support Early
Childhood Home Visiting in New York. As highlighted in these guides, New York is home to a number
of examples of blending and braiding models to support early childhood programs and organizations.
For example, the Parent-Child Home Program (PCHP) is a research-validated program that equips
parents with young children with knowledge, skills and materials to foster their children’s academic
success via community-based early literacy specialists who conduct home visits during which they model
behaviors that enhance children’s development, such as the use of engaging books and stimulating
toys. New York’s 24 PCHP sites receive 95% of their funding from private foundations, United Ways
and individual and corporate donors, much of which can be blended into one pot given the flexibility
of these private funding sources. These funds are then braided with the 5% of funding sites receive
from federal, state, local and school district governments, since these public funders have specific
eligibility, reporting and tracking requirements.

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Blending and Braiding to Support Early Childhood at the State Level
    A number of other states are blending and braiding funds to support early childhood. For example,
    in Arizona, Colorado, California, Florida, Georgia, Illinois, Louisiana, Nebraska, New Mexico, New
    York and Oklahoma, state regulations allow for applying Child Care and Development Block Grant
    (CCDBG) funds to support additional care before and after state pre-K program hours. In California
    and Florida, non-CCDBG state funds can be used to continue subsidies for families who no longer meet
    CCDBG eligibility. In Arizona, California, Colorado, Georgia, Nebraska, New York and Oklahoma,
    Head Start comprehensive service components can be extended during pre-K program participation
    hours.

    Louisiana’s Permanent Supportive Housing Program
    Louisiana’s permanent supportive housing program is a cross-agency partnership administered jointly
    by the state’s Medicaid agency and housing authority. Permanent supportive housing combines
    housing assistance with optional individualized services including counseling, addiction services, and
    support with daily living skills and activities – in Louisiana’s case, specifically for those with substantial
    physical and/or behavioral disabilities that require housing supports to live in the community. The
    program braids funding (from Community Development Block Grant disaster recovery funds,
    federal rental assistance programs, housing development support from the Low Income Housing
    Tax Credit, and funding for services from Medicaid, the U.S. Substance Abuse and Mental Health
    Services Administration, and other sources) to serve vulnerable cross-disability populations, address
    homelessness, reduce institutionalizations, and save money for the state.

    Rhode Island’s Health Equity Zones
    Rhode Island’s Health Equity Zone initiative braids together funds from several federal, state and
    local sources of prevention, categorical disease and population health funding to create place-based
    “Health Equity Zones”. These geographic areas are “designed to achieve health equity by eliminating
    health disparities and promoting healthy communities”. Instead of the traditional model of providing
    communities separate sources of funding to implement specific programs or address specific health
    issues, the Rhode Island Department of Health provides communities with combined funding that
    enables these communities to work together – realigning staff, breaking down organizational silos, and
    promoting cross-sector collaboration – to achieve shared goals for sustained community health and
    well-being.

    Washington State’s Accountable Communities of Health
    Part of Washington State’s Healthier Washington initiative, the state’s Accountable Communities of
    Health (ACHs) focus on community based, cross-sector work to improve health in their respective
    regions. The ACHs braid together federal State Innovation Model (SIM) grant funding and/or
    funds set aside by the state legislature with grants and contributions from private and public sector
    organizations. Healthier Washington is being spearheading by the Washington State Healthcare
    Authority (HCA) in partnership with the Department of Health and the Department of Social and
    Health Services. In addition to funding, this initiative offers the state’s nine ACHs other resources,
    including technical assistance.

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References
Note: References listed below in order they appear in text                TypologyChart_WB_Let_112018.pdf.
                                                                          Hester JA and Stange, PV (March 2014). A Sustainable Financial
Butler, SM and Cabello M (March 2018). Housing as a hub for               Model for Community Health Systems. Accessed at: https://
health, community services, and upward mobility. Brookings Institution.   carsey.unh.edu/sites/carsey.unh.edu/files/media/pdf/bph-
Accessed at: https://www.brookings.edu/research/housing-as-a-             sustainablefinancialmodel1.pdf.
hub-for-health-community-services-and-upward-mobility/.
                                                                          Kindig, DA and Milstein B (2018). A Balanced Investment
Fazili, S (December 2017). Can Community Development Improve              Portfolio For Equitable Health And Well-Being Is An
Health? Emerging Opportunities for Collaboration between the Health       Imperative, And Within Reach. Health Affairs, 37(4), 579-584.
and Community Development Sectors. Federal Reserve Bank of                Accessed at: https://www.healthaffairs.org/doi/full/10.1377/
Atlanta. Accessed at: https://www.frbatlanta.org/-/media/                 hlthaff.2017.1463.
documents/community-development/publications/discussion-
papers/2017/03-can-community-development-improve-                         Kholi J and De Biasi A (2017). Supporting healthy communities:
health-2017-12-05.pdf.                                                    How rethinking the funding approach can break down silos
                                                                          and promote health and health equity. Deloitte University
National Academies of Sciences, Engineering, and Medicine                 Press: https://www2.deloitte.com/content/dam/insights/us/
(2018). Exploring early childhood care and education levers to improve    articles/3608_supporting-healthy-communities/DUP_supporting-
population health: Proceedings of a workshop. Washington, DC: The         healthy-communities.pdf.
National Academies Press. Accessed at: http://nationalacademies.
org/hmd/Reports/2018/exploring-early-childhood-care-and-                  U.S. Department of Health and Human Services and U.S.
education-levers-to-improve-pop-health-workshop-proceedings.              Department of Education (2016). Policy Statement to Support the
aspx.                                                                     Alignment of Health and Early Learning Systems. Accessed at: https://
                                                                          www.acf.hhs.gov/sites/default/files/ecd/health_early_learning_
Spencer, A and Freda, B (October 2016). Advancing State                   statement.pdf.
Innovation Model Goals through Accountable Communities for Health.
Center for Health Care Strategies, Inc. Accessed at: https://www.         U.S. Department of Education (2014). Performance Partnerships
chcs.org/media/SIM-ACH-Brief_101316_final.pdf.                            for Disconnected Youth. Accessed at: https://www.ed.gov/blog/wp-
                                                                          content/uploads/2014/03/2014-PPPs-Fact-Sheet.pdf.
Mikkelsen L and Harr, WL (July 2015). Accountable Communities
for Health: Opportunities and Recommendations. Prevention                 Performance Partnership Pilots for Disconnected Youth (June
Institute. Accessed at: https://www.preventioninstitute.org/              2017). Performance Partnership Pilots for Disconnected Youth: First
publications/accountable-communities-health-opportunities-and-            Annual Report to Congress. Accessed at: https://youth.gov/sites/
recommendations.                                                          default/files/P3-Report-to-Congress-508.pdf.

Purpose Built Communities (2018). A Network of Partners Sharing a         Flynn M and Hayes CD (January 2003). Blending and Braiding
Vision for the Future. Accessed at: https://purposebuiltcommunities.      Funds to Support Early Care and Education Initiatives. The Finance
org/our-network/.                                                         Project. Accessed at: http://www.karenhillscott.com/downloads/
                                                                          publications/5-3_blending-braiding_funds.pdf.
Invest Health (2018). Invest Health Strategies for Healthier Cities: A
Project of the Robert Wood Johnson Foundation and Reinvestment Fund.      Guides and Toolkits
Accessed at: https://www.investhealth.org/.
                                                                          Association of Government Accountants (December 2014).
Trust for America’s Health (November 2016). Blueprint for a               Blended and Braided Funding: A Guide for Policy Makers and
Healthier America 2016: Policy Priorities for the Next Administration     Practitioners. Accessed at: https://www.agacgfm.org/Intergov/
and Congress. Accessed at: https://www.tfah.org/report-details/           More-Tools/Blended-and-Braided-Funding-A-Guide-for-Policy-Ma.
blueprint-for-a-healthier-america-2016-policy-priorities-for-the-         aspx.
next-administration-and-congress/.
                                                                          National Academy for State Health Policy (December 2017).
Trust for America’s Health (August 2015). Options for Financing           Blending, Braiding, and Block-Granting Funds for Public Health and
Community Prevention Efforts to Improve Health. Accessed at:              Prevention: Implications for States. Accessed at: https://nashp.org/
https://www.tfah.org/wp-content/uploads/archive/health-                   wp-content/uploads/2017/12/deBeaumont.pdf.
issues/2015/08/Community-prevention.pdf.
                                                                          Clary A and Riley T (February 2016). Braiding & Blending Funding
Georgia Health Policy Center (October 2016). Financing for                Streams to Meet the Health-Related Social Needs of Low-Income Persons:
Population Health. Accessed at: http://cachi.org/uploads/                 Considerations for State Health Policymakers. National Academy for
resources/Bridging-for-health-financing-report.pdf.                       State Health Policy. Accessed at: https://nashp.org/wp-content/
                                                                          uploads/2016/02/Jean1.pdf.
ReThink Health (March 2018). A Typology of Potential Financing
Structures for Population Health. Accessed at: https://www.
rethinkhealth.org/wp-content/uploads/2018/03/RTH-
                                                                                                                          TFAH • www.TFAH.org      9
Spark Policy Institute (2014). Blending & Braiding Toolkit. Accessed         Chicanos Por La Causa [Website]. Accessed at: https://www.cplc.
     at: http://tools.sparkpolicy.com/overview-blending-braiding/.                org/.

     Cantor J, Tobey R, Houston K, and Greenberg E (May 2015).                    United Health Group (February 2016). UnitedHealthcare and
     Accountable Communities for Health: Strategies for Financial                 Chicanos Por La Causa Open myCommunity Connect Center in Maryvale
     Sustainability. JSI Research & Training Institute, Inc. Accessed at:         to Broaden Access to Social Services for Low-Income Residents. Accessed
     https://www.jsi.com/JSIInternet/Inc/Common/_download_pub.                    at: https://www.unitedhealthgroup.com/newsroom/2016/0218my
     cfm?id=15660&lid=3.                                                          communityconnectcenter.html.

     Wallen M and Hubbard A (November 2013). Blending and Braiding                Sojourner Family Peace Center [Website]. Accessed at: https://
     Early Childhood Program Funding Streams Toolkit: Enhancing Financing         familypeacecenter.org/.
     for High-Quality Early Learning Programs. Ounce of Prevention Fund.
     Accessed at: https://qrisnetwork.org/sites/all/files/resources/              State Examples
     mrobinson%40buildinitiative.org/2014-01-17%2011%3A36/
     Blending%20and%20Braiding%20Early%20Childhood%20                             Clary A and Riley T (June 2016). Pooling and Braiding Funds for
     Program%20Funding%20Streams%20Toolkit.pdf.                                   Health-Related Social Needs: Lessons from Virginia’s Children’s Services
                                                                                  Act. National Academy for State Health Policy. Accessed at:
     National Collaborative on Workforce and Disability (January 2006).           https://nashp.org/wp-content/uploads/2016/06/CSA-Virginia-
     Blending and Braiding Funds and Resources: The Intermediary as               Brief-1.pdf.
     Facilitator. Accessed at: http://www.ncwd-youth.info/wp-content/
     uploads/2016/08/Blending-and-Braiding-Funds-and-Resources-                   De Biasi A, Mays A, Mathew S, and Niebuhr D (April 2017).
     Intermediary.pdf.                                                            Behavioral Health 101: Exploring Best Practices for Behavioral
                                                                                  Health in Schools [Webinar]. Trust for America’s Health
     Federal Initiatives                                                          and Healthy Schools Campaign. Accessed at: https://
                                                                                  healthyschoolscampaign.org/wp-content/uploads/2017/04/HSPF-
     U.S. Department of Education (2014). Performance Partnerships                Behavioral-Health-Webinar-edits.pdf.
     for Disconnected Youth. Accessed at: https://www.ed.gov/blog/wp-
     content/uploads/2014/03/2014-PPPs-Fact-Sheet.pdf.                            Colorado’s Trauma Informed System of Care [Website]. Accessed
                                                                                  at: https://coactcolorado.org/about.
     U.S. Department of Education, Office of Innovation &
     Improvement. Promise Neighborhoods. Accessed at: https://                    Colorado Foundation for Public Health and the Environment.
     innovation.ed.gov/what-we-do/parental-options/promise-                       Blending and Braiding Your TANF Initiative (BBYT) (2). Accessed at:
     neighborhoods-pn/.                                                           http://www.cfphe.org/blending-and-braiding-your-tanf-initiative-
                                                                                  bbyt-2/.
     Substance Abuse and Mental Health Services Administration
     (2017). Now Is The Time Technical Assistance Center. Accessed at:            Lynn, J (January 2011). Colorado Guide to Blending & Braiding: Step
     https://www.samhsa.gov/nitt-ta.                                              by step instructions to develop and expand fiscal coordination. Denver,
                                                                                  CO: Blending and Braiding Your TANF, Spark Policy Institute.
     State and Local Examples                                                     Accessed at: https://coactcolorado.org/site_media/media/servee_
                                                                                  documents/Blending_and_Braiding_Funding_Guide.pdf.
     Local Examples
                                                                                  Obee, K and Lynn, J (January 2011). Colorado Guide to TANF for
     Family League of Baltimore [Website]. Accessed at: http://                   Local Communities - Over 50 Ways to Use Your TANF. Denver, CO:
     familyleague.org/.                                                           Blending and Braiding Your TANF, Spark Policy Institute. Accessed
                                                                                  at: http://ncfie.net/wp-content/uploads/2017/01/Spark_TANF_
     Florida Children’s Council [Website]. Overview: What’s a Children’s          Guide.pdf.
     Services Council? Accessed at: http://flchildrenscouncil.org/about-
     cscs/overview/.                                                              Portman–Marsh N, Leeper L and Lynn J (January 2011). Colorado
                                                                                  Guide to Partnering with Funders: A guide for communities, advocates,
     Trust for America’s Health (March 2017). How Embedding                       and nonprofits. Denver, CO: Blending and Braiding Your TANF,
     Health Access and Nurses in Schools Improves Health in Grand                 Center for Systems Integration. Accessed at: https://www.
     Rapids, Michigan. Accessed at: https://www.tfah.org/story/how-               agacgfm.org/getattachment/Training-and-Events/Learn-Online/
     embedding-health-access-and-nurses-in-schools-improves-health-in-            Webinars/2015-2016-Offerings/011817-blended-and-braided-
     grand-rapids-michigan/.                                                      funding/Materials-042617/Colorado-Guide3-Partnering-With-
                                                                                  Funders-2011.pdf.aspx?lang=en-US.
     Hacker K, Monroe C, and Yonas M (November 2017). Innovative
     partnerships to support successful public health infrastructure. Allegheny   Obee K, McHugh DW, Lynn J, Portman-Marsh N (October 2013).
     County Health Department and The Pittsburgh Foundation.                      Early Childhood Guide to Blending and Braiding in New York. Denver,
     American Public Health Association Annual Meeting & Expo 2017:               CO: Spark Policy Institute. Accessed at: http://www.nysecac.
     Atlanta, GA [Poster Session Presentation]. Accessed at: https://             org/files/6715/1334/9855/Final_-_NY_BlendBraid_Guide-
     apha.confex.com/apha/2017/meetingapp.cgi/Paper/380704.                       FINAL_12_16_13__For_Booklet_Printing_Rev_12-15-17.pdf.

10     TFAH • www.TFAH.org
McHugh DW, Lynn J, Obee K, Portman-Marsh N (January 2014).              Rhode Island Department of Health (August 2018). Health Equity
Blending and Braiding to Support Early Childhood Home Visiting in New   Zones: Building healthy and resilient communities across Rhode Island.
York. Denver, CO: Spark Policy Institute. Accessed at: http://www.      Accessed at: http://www.health.ri.gov/publications/brochures/
nysecac.org/files/2413/9169/5014/FINAL_NY_HV_BBGuide__                  HealthEquityZones.pdf.
No_Medicaid_1_8_14.pdf.
                                                                        Clary A (December 2017). Lessons from Rhode Island: How to
Parent-Child Home Program [Website]. Accessed at: http://www.           Effectively Blend, Braid, and Use Block Grant Funds to Improve Public
parent-child.org/.                                                      Health. National Academy for State Health Policy. https://nashp.
                                                                        org/lessons-from-rhode-island-how-to-effectively-blend-braid-and-
Early Care and Education Consortium (2014). Blending and                use-block-grant-funds-for-public-health-and-prevention/.
Braiding to Support High Quality Child Care. Accessed at: http://www.
ececonsortium.org/wp-content/uploads/2014/01/Braiding-One-              Heider F, Kniffin T and Rosenthal J (May 2016). State Levers to
pager-Jan24.pdf.                                                        Advance Accountable Communities for Health: Washington State Profile.
                                                                        National Academy for State Health Policy. Accessed at: https://
Clary A and Kartika T (May 2017). Braiding Funds to House Complex       nashp.org/wp-content/uploads/2016/05/WA-State-Profile.pdf.
Medicaid Beneficiaries: Key Policy Lessons from Louisiana. National
Academy for State Health Policy. Accessed at: https://nashp.org/
wp-content/uploads/2017/05/Braiding-Funds-Louisiana.pdf.

                                                                                                                         TFAH • www.TFAH.org     11
Supplement: Braiding and Blending Funds to Support Early Childhood
     Resources

     Blending and Braiding Early Childhood Program Funding Streams Toolkit
     This 2013 toolkit from the Ounce of Prevention Fund is designed to provide state advocates and
     policymakers with strategies, tools, resources and options to make policy choices that facilitate blending
     and braiding funding streams to improve early learning programs for vulnerable children and working
     families. The toolkit includes state data tables and worksheets to facilitate an understanding of the
     current funding landscape within a state.

     Leveraging Individuals with Disabilities Education Act (IDEA) Funds
     This 2017 presentation from the IDEA Fiscal Forum discusses ways to leverage funds to meet the needs
     of students with disabilities, including braiding or blending IDEA funds with Title I and Title III funds
     and consolidating IDEA and other federal funds with state and local funds to support schoolwide
     programs.

     Braiding, Blending, and Layering Funding Sources to Increase access to Quality Preschool
     This 2016 state technical assistance report from Preschool Development Grants (PDG) examines
     braiding, blending, and layering funding streams to support and sustain high quality preschool
     programs. The report outlines these strategies in the context of Early Head Start and related funds,
     describes benefits and challenges of these strategies, and profiles examples of states implementing
     these strategies – Illinois, Pennsylvania, and Vermont.

     Local Examples

     Family League of Baltimore
     The Family League of Baltimore is a nongovernmental local management board, established in 1991 by
     the Maryland General Assembly, to target government resources to local organizations and coordinate
     services for child and family services. Family League partners with a variety of organizations, including
     My Brother’s Keeper Baltimore and the Family Literacy Coalition, to fund and support capacity
     building; collaboration; the reduction of duplicate services among public and private stakeholders;
     wider implementation of evidence-based programs; and the promotion of policy and practice system
     changes. The program receives support from around 40 different funders to support a total budget
     of $29.6 million (in 2016), including around $13 million from state grants; $13 million from local
     government grants; $1.5 million in private grants; and $500,000 in federal grants. Around 93 percent
     of funds are from government grants. Eighty percent is distributed to local organizations, 10 percent
     supports technical assistance and 10 percent supports management and administration. As one
     example effort, through B’more for Healthy Babies, the Family League of Baltimore is working with
     the Baltimore Health Department to reduce infant mortality and improve the health of mothers and
     babies through fitness and nutrition for postpartum women, hosting breastfeeding support groups
     and conducting intensive community outreach to connect women with services. Infant mortality has
     been reduced by 28 percent since the start of the initiative and is at the lowest point in history. And the
     disparity between White and Black infant deaths has been reduced by nearly 40 percent.

     Florida Children’s Services Councils
     In Florida, state legislation enables counties to levy a tax or set aside a portion of their annual budget

12    TFAH • www.TFAH.org
– subject to voter approval – to fund a government entity called a Children’s Services Council (CSC).
These councils help fund organizations that serve children and families in the county where a council
exists. The councils also help make sure dollars are invested in programs that will provide the best
outcomes for children and families in their communities, with priorities aligned with the community’s
needs. Among other activities, councils monitor program/provider performance and serve as a hub,
convening child advocacy partners and providing leadership, coordination and oversight.

Spectrum’s School Health Program at Grand Rapids Public Schools
The School Health Program in Grand Rapids Public Schools (GRPS) in Michigan is a partnership
between the school district and Spectrum Health (a large health system in the area). The program
utilizes school health teams composed of registered nurses, licensed practical nurses and health
aides to provide direct services to students in 48 schools, including via four full-service school based
health centers. The program coordinates funding from several sources to support their school nurses
(Spectrum Health, the district budget, the local school district budget, and the State Department of
Education – including grants and funds set aside for students deemed high risk), and further braids
together public and private funding streams to allow for reimbursement and service provision under
a variety of health delivery models beyond the traditional school nurse reimbursement model. This
enables GRPS to provide services outside of the traditional school nurse model, such as dental services.
GRPS also partners with a local Federally Qualified Health Center (FQHC) to deliver health services
in their school-based health centers and via a traveling dental program. Because these services are
provided through an FQHC, they are eligible for Medicaid reimbursement and receive the FQHC
enhanced reimbursement rate. The School Health Program has produced significant improvements
in key school health indicators. In FY 2015, 97% of students at participating schools met current
immunization requirements to attend school and 98% of problems identified were resolved on-site by
the school health care team.

State Examples

Virginia Children’s Services Act
Virginia’s Children’s Services Act is a case management model that blends funding streams across
state agencies (social services, juvenile justice, education, and behavioral health) and allocates these
funds to localities to support the needs of at-risk youth and families. It is overseen by a cross-agency
State Executive Council for Children’s Services. The local funds are received and managed by the local
Community Policy and Management Team (CPMT), which is appointed by the local governing body.
The CPMTs authorize the funds to pay for the services recommended by the local Family Assessment
and Planning (FAPT) teams. Localities also contribute matching funds to the CSA state pool and
report to the state on pool expenditures as a whole; they do not report on expenditures by stream.
At-risk youth are referred through a range of individuals or organizations or schools — and assigned
to the local assessment and planning team who develop an individualized plan. A case manager
helps the youth navigate and receive available services — including education, healthcare, housing,
transportation and food assistance. Through improved coordination of services and funding streams,
case managers have the flexibility to focus on tailoring services to the youth’s needs and avoiding
unnecessary bureaucracy.

Colorado Department of Education’s School Behavioral Health Services
The Colorado Department of Education provides behavioral health and substance use prevention
support in schools by funding full-time psychologists, social workers, counselors and nurses;

                                                                                        TFAH • www.TFAH.org   13
professional development and training; and resources to implement evidence-based programs for
     substance use prevention, including universal screening. These efforts are financed by braiding funds
     from marijuana taxes with funds from Medicaid and grants from the Substance Abuse and Mental
     Health Services Administration as well as state-level personnel development and bullying prevention
     and education grants.

     Colorado Department of Human Services Blending and Braiding Initiatives
     Colorado’s Trauma Informed System of Care (COACT Colorado) involves all child and youth service
     agencies in the state (including the public mental health system, child welfare, juvenile justice and
     education) and aims to develop a sustainable infrastructure to coordinate and fund services for families
     of children and youth with complex needs. COACT Colorado is currently supporting 15 communities
     across 17 counties. In El Paso County, the state is piloting a care management entity, a centralized
     organization that blends funding, organizes services and supports, and serves as a hub of accountability
     across agencies.

     The Colorado Department of Human Services has also embarked on a Blending and Braiding Your
     TANF (BBYT) Initiative, which includes technical assistance, tools, training, and demonstration
     projects in six counties to help local communities learn to blend and braid multiple funding streams
     with their Temporary Assistance for Needy Families (TANF) funds to support evidence-based and best
     practice services, while still complying with TANF’s transparency and accountability requirements. As
     part of this initiative, BBYT collaborated with Spark Policy Institute and others to produce guides on
     blending and braiding, TANF for local communities and partnering with funders.

     Blending and Braiding to Support Early Childhood in New York
     To support efforts to blend and braid funds, the New York State Early Childhood Advisory Council
     Finance Work Group commissioned Spark Policy Institute to produce state-specific guides, Early
     Childhood Guide to Blending and Braiding in New York and Blending and Braiding to Support Early
     Childhood Home Visiting in New York. As highlighted in these guides, New York is home to a number
     of examples of blending and braiding models to support early childhood programs and organizations.
     For example, the Parent-Child Home Program (PCHP) is a research-validated program that equips
     parents with young children with knowledge, skills and materials to foster their children’s academic
     success via community-based early literacy specialists who conduct home visits during which they model
     behaviors that enhance children’s development, such as the use of engaging books and stimulating
     toys. New York’s 24 PCHP sites receive 95% of their funding from private foundations, United Ways
     and individual and corporate donors, much of which can be blended into one pot given the flexibility
     of these private funding sources. These funds are then braided with the 5% of funding sites receive
     from federal, state, local and school district governments, since these public funders have specific
     eligibility, reporting and tracking requirements.

     Blending and Braiding to Support Early Childhood at the State Level
     A number of other states are blending and braiding funds to support early childhood. For example, in
     Arizona, Colorado, California, Florida, Georgia, Illinois, Louisiana, Nebraska, New Mexico, New York
     and Oklahoma, state regulations allow for applying Child Care and Development Block Grant (CCDBG)
     funds to support additional care before and after state pre-K program hours. In California and Florida,
     non-CCDBG state funds can be used to continue subsidies for families who no longer meet CCDBG
     eligibility. In Arizona, California, Colorado, Georgia, Nebraska, New York and Oklahoma, Head Start
     comprehensive service components can be extended during pre-K program participation hours.

14    TFAH • www.TFAH.org
References
Note: References listed below in order they appear in text                 Colorado’s Trauma Informed System of Care [Website]. Accessed
                                                                           at: https://coactcolorado.org/about.
Wallen M and Hubbard A (November 2013). Blending and Braiding              Colorado Foundation for Public Health and the Environment.
Early Childhood Program Funding Streams Toolkit: Enhancing Financing       Blending and Braiding Your TANF Initiative (BBYT) (2). Accessed at:
for High-Quality Early Learning Programs. Ounce of Prevention Fund.        http://www.cfphe.org/blending-and-braiding-your-tanf-initiative-
Accessed at: https://qrisnetwork.org/sites/all/files/resources/            bbyt-2/.
mrobinson%40buildinitiative.org/2014-01-17%2011%3A36/
Blending%20and%20Braiding%20Early%20Childhood%20                           Lynn, J (January 2011). Colorado Guide to Blending & Braiding: Step
Program%20Funding%20Streams%20Toolkit.pdf.                                 by step instructions to develop and expand fiscal coordination. Denver,
                                                                           CO: Blending and Braiding Your TANF, Spark Policy Institute.
Schreier D and Kniseley C (2017). Leveraging IDEA                          Accessed at: https://coactcolorado.org/site_media/media/servee_
Funds [Presentation]. IDEA Fiscal Forum. Accessed at:                      documents/Blending_and_Braiding_Funding_Guide.pdf.
https://cifr.wested.org/wp-content/uploads/2017/03/
BlendingAndBraidingFundsIFF2016.pdf.                                       Obee, K and Lynn, J (January 2011). Colorado Guide to TANF for
                                                                           Local Communities - Over 50 Ways to Use Your TANF. Denver, CO:
Fonseca M (2016). Braiding, Blending, and Layering Funding                 Blending and Braiding Your TANF, Spark Policy Institute. Accessed
Sources to Increase Access to Quality Preschool. PDG, State Technical      at: http://ncfie.net/wp-content/uploads/2017/01/Spark_TANF_
Assistance Report. Accessed at: https://pdg.grads360.org/services/         Guide.pdf.
PDCService.svc/GetPDCDocumentFile?fileId=26705.
                                                                           Portman–Marsh N, Leeper L and Lynn J (January 2011). Colorado
Local Examples                                                             Guide to Partnering with Funders: A guide for communities, advocates,
                                                                           and nonprofits. Denver, CO: Blending and Braiding Your TANF,
Family League of Baltimore [Website]. Accessed at: http://                 Center for Systems Integration. Accessed at: https://www.
familyleague.org/.                                                         agacgfm.org/getattachment/Training-and-Events/Learn-Online/
                                                                           Webinars/2015-2016-Offerings/011817-blended-and-braided-
Florida Children’s Council [Website]. Overview: What’s a Children’s        funding/Materials-042617/Colorado-Guide3-Partnering-With-
Services Council? Accessed at: http://flchildrenscouncil.org/about-        Funders-2011.pdf.aspx?lang=en-US.
cscs/overview/.
                                                                           Obee K, McHugh DW, Lynn J, Portman-Marsh N (October 2013).
Trust for America’s Health (March 2017). How Embedding                     Early Childhood Guide to Blending and Braiding in New York. Denver,
Health Access and Nurses in Schools Improves Health in Grand               CO: Spark Policy Institute. Accessed at: http://www.nysecac.
Rapids, Michigan. Accessed at: https://www.tfah.org/story/how-             org/files/6715/1334/9855/Final_-_NY_BlendBraid_Guide-
embedding-health-access-and-nurses-in-schools-improves-health-in-          FINAL_12_16_13__For_Booklet_Printing_Rev_12-15-17.pdf.
grand-rapids-michigan/.
                                                                           McHugh DW, Lynn J, Obee K, Portman-Marsh N (January 2014).
State Examples                                                             Blending and Braiding to Support Early Childhood Home Visiting in New
                                                                           York. Denver, CO: Spark Policy Institute. Accessed at: http://www.
Clary A and Riley T (June 2016). Pooling and Braiding Funds for            nysecac.org/files/2413/9169/5014/FINAL_NY_HV_BBGuide__
Health-Related Social Needs: Lessons from Virginia’s Children’s Services   No_Medicaid_1_8_14.pdf.
Act. National Academy for State Health Policy. Accessed at:
https://nashp.org/wp-content/uploads/2016/06/CSA-Virginia-                 Parent-Child Home Program [Website]. Accessed at: http://www.
Brief-1.pdf.                                                               parent-child.org/.
De Biasi A, Mays A, Mathew S, and Niebuhr D (April 2017).                  Early Care and Education Consortium (2014). Blending and
Behavioral Health 101: Exploring Best Practices for Behavioral             Braiding to Support High Quality Child Care. Accessed at: http://www.
Health in Schools [Webinar]. Trust for America’s Health                    ececonsortium.org/wp-content/uploads/2014/01/Braiding-One-
and Healthy Schools Campaign. Accessed at: https://                        pager-Jan24.pdf.
healthyschoolscampaign.org/wp-content/uploads/2017/04/HSPF-
Behavioral-Health-Webinar-edits.pdf.

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